Affiliation:
1. Division of General Pediatrics The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
2. Clinical Futures and PolicyLab The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
3. Leonard Davis Institute of Health Economics Philadelphia Pennsylvania USA
4. Division of Emergency Medicine The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
5. Department of Nursing and Clinical Care Services The Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
6. Department of Pediatrics The Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA
7. Department of Medicine The Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA
8. Department of Medical Ethics and Health Policy The Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USA
Abstract
AbstractBackgroundChildren hospitalized in medical hospitals are at risk of agitation. Physical restraint may be used to maintain patient and staff safety during de‐escalation, but physical restraint use is associated with physical and psychological adverse events.ObjectiveWe sought to better understand which work system factors help clinicians prevent patient agitation, improve de‐escalation, and avoid physical restraint.Design, Setting, and ParticipantsWe used directed content analysis to extend the Systems Engineering Initiative for Patient Safety model to clinicians working with children at risk for agitation at a freestanding children's hospital.Intervention, Main Outcome, and MeasuresWe conducted semistructured interviews to examine how five clinician work system factors affected patient agitation, de‐escalation, and restraint: person, environment, tasks, technology and tools, and organization. Interviews were recorded, transcribed, and analyzed until saturation.ResultsForty clinicians participated in this study, including 21 nurses, 15 psychiatric technicians, 2 pediatric physicians, 1 psychologist, and 1 behavior analyst. Work system factors that contributed to patient agitation were medical tasks like vital signs and the hospital environment including bright lights and neighboring patients' noises. Supports that helped clinicians de‐escalate patients included adequate staffing and accessible toys and activities. Participants indicated that organizational factors were integral to team de‐escalation, drawing connections between units' teamwork and communication cultures and their likelihood of successful de‐escalation without the use of physical restraint.ConclusionClinicians perceived that medical tasks, hospital environmental factors, clinician attributes, and team communication influenced patients' agitation, de‐escalation, and physical restraint. These work system factors provide opportunities for future multi‐disciplinary interventions to reduce physical restraint use.
Subject
Assessment and Diagnosis,Care Planning,Health Policy,Fundamentals and skills,General Medicine,Leadership and Management
Cited by
4 articles.
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